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All Episodes Delete Edit HRV Technology for Greater Awareness with Guest Rohan Dixit June 27, 2023 Serena Ward, MLE, MHM, EBE and Tina Hallock, MLE, MHM, EBE Season: 3 Episode: 42 Description Transcript
Tina: Hey everyone, I'm Tina
Serena: and I'm Serena and we are the mental health mamas.
Tina: Welcome to no need to explain. We are so glad you're here.
Serena: First, as always, a quick disclaimer.
Tina: We come to you not as mental health professionals or experts in the field, but rather as parents with lived experience who are on a mission to normalize the conversation around mental health.
Serena: If you or someone you love is experiencing a mental health crisis, please seek professional support. You'll find a variety of resources in our show notes and on our website noneedtoexplain podcast.com.
Tina: Serena and I often talk about our mental health toolboxes and all the
different things that we can add and sometimes subtract. One of the best parts about having a podcast is that we are often adding tools to our box that we learn about from our guests.
Serena: Yes, absolutely. I've added so many tools during the time that we've been sharing this podcast with the world, and today we are excited to share a tool with you that was new to us and sounds like a really great addition to the toolbox.
Tina: Joining us today to talk about this tool is Rohan Dix. Rohan is a neuroscientist who studied at Harvard in Stanford, an entrepreneur and CEO and founder of Leaf Therapeutics. Rohan, welcome to the podcast.
Rohan: It?s great to be here.
Serena: So Rohan, you come to us with a whole bunch of credentials and you've done some amazing work in neuroscience. But as is often the case, I imagine you were drawn to this field for a very specific reason. So, share a little bit with us about what led you to this field.
Rohan: So, I got into mental health because I struggled with mental health. Maybe similar to other people out there. Yeah, as an adult and as a teenager had my own challenges with anxiety and depression and was able to find a way out of it and continue to live and grow, although it was a little bit of a rough along the way. And so, I've really dedicated my life to making better mental health tools for people that I wish I had.
Serena: So, I'm curious for Rohan if, or not so much if, but what was it like growing up in your house? Was mental health something that was talked about?
Rohan: You know, so my parents were both physicians and so you might expect that because, you know, they?re doctors that was something that was talked about a lot, but it really wasn't. And then, you know, I'm culturally Indian, I'm not sure that mental health is really, you know, the thing that all parents are talking to their kids about,
you know, on a regular basis. At least I wasn't my experience, although my parents are amazing and so supportive and great. I think there were certain things that I still had struggles with. And so, I think I was lucky at the time to stumble across, you know, one of the many techniques
you guys have covered on these podcasts for improving mental health, one of which is mindfulness meditation and my mom had a book about that lying around the house. I came across the one day, started reading this and sort of practicing what was in there and that was kind of the beginning of learning that, oh, there are techniques out there where you can have some regains and control over your mind and your thoughts and yeah, that was really, also what inspired me to become a
neuroscientist because I kind of felt that something must have changed my brain in doing some of these practices.
Tina: Yeah, so we'll circle back to a bit of that in a moment, but what I want to say is thank you for being vulnerable and, you know, never do we want to come off on the podcast as being judgey of previous generations. We're just being observant and I think the fact that in our day and we're clearly older than you, but the idea that it isn't always normalized even by the people who we might expect to normalize those things. So I appreciate your comments about that for sure.
Rohan: Of course, no, and I just wanted to thank you guys for providing this open platform for it because I think I mean, how are we all going to get to a place where we're able to have these conversations with not by being open about it. So I just really appreciate, you know, the work you
Tina: Thanks. So we understand that you've studied different states of consciousness and what our brains look like in these different states, which I think is absolutely fascinating when I see that research. So what can you share with us about the research as it relates to our mental
Rohan: Yeah, so the primer on the brain for anyone who hasn't, you know, hasn't spent a lot of time learning about neuroscience. So our brains are made up of networks and then, you know, there's
all these different parts of our brain and some of them are localized to certain places, even physically, like on our underneath our skull, in our cortex and these networks, they kind of come together all at once. And so let's say, you know, you're perceiving an orange and you're saying,
well, I've got this orange in front of me. So, you know, where's the orange part of my brain? Well, there isn't one, right? It's a network of a sensory part of your cortex lighting up. So maybe that's the smell of the faint rhyme that you can kind of smell. You know, maybe that's the
sensation that touched this in that sensory input of feeling that over your hand and the roughness against your fingertips, the color of it, right? Your visual cortex, all of these things are coming together and creating this conscious percept and perception, this awareness of an orange. And similarly, you know, our mind works as a network with many different components, generating a conscious perception together for even internal states. And so one of the first labs that I worked in Mike Gracius? lab at Stanford. And he's one of the earliest kind of pioneers of this state, field neuroscience called the default mode. And the default mode is such an interesting kind of window into the human mind and consciousness because it was actually discovered by accident. Typically, when you're doing brain experiments, you're putting people in these very expensive MRI machines and, you know, the scientists slave away for months, you know, creating the perfect experiment to go in there and get everything you need all the right data. But it turns out that somebody once lost the machine reading in between experiments in between these cognitive tasks and all the stuff that we do to try to understand the brain. And what kind of emerged from that was gosh, actually, when your mind's not doing anything, it actually is doing something. That's the default mode of the human mind that is activated and creating an internal perception and internal state of consciousness, even without being externally focused on the outer world. And that is, I think, one of the pieces that we engage when we do practices like mindfulness,
perhaps even certain types of CBT. And certainly there's a variety of different self-regulation practices that center on that network in the brain. And so that's maybe a short primer into part systems in the brain that support conscious perception.
Serena: That's fascinating. So we're going to shift a little bit now to the idea of heart rate, variability, and anxiety. And you've created a tool that utilizes this to support individuals in managing anxiety. So tell us how this works.
Rohan: Yeah, so I mean, I told you that I struggled with anxiety and mental health myself. And so, you know, being a scientist in the space is more than an academic interest. I wanted to actually feel better. And so I'm a tinkerer and inventor and I love to make little gadgets. And I've done that as a kid. And so, you know, you have a hammer everything looks like a nail. So I'm like, well, let me start tinkering and try to make a machine that can help me. And maybe because of my experience early on reading my mom's book about meditation, I initially kind of conceived at this tool as a aid for learning how to meditate myself,
you know, without needing to necessarily, you know, read about meditation or try to guess what I needed to do, but instead to measure what's happening inside me and create a feedback loop to learn
faster. I think sometimes these meditation machines is almost like a feedback. Imagine that you're trying to have a play basketball write-in. Well, you want to shoot the ball into the hoop but the question is, are you able to, if you were blindfolded and shooting the ball,
learn how to do that effectively? And of course, the answer is no, right? You need that visual feedback loop. You know, I did this and I did that and I changed my shot here. And okay, now it went in the hoop. But the state with meditation is such that you really don't know when you're doing it well and you don't know when you're not doing it well. Especially at the beginning stages when we all need the most support and help and that was my experience too. So initially, I started playing
around with sensors that could measure brain activity. And those sensors, there's a variety of them, but one of the very accessible ones is called an electroencephalograph on EEG. And EEG is measuring, you know, it's kind of like the very short time scale electrical activity of your brain and it kind of seeps out through your skull and gets messed up a little bit. But you can measure it. And you can kind of tell a little bit, you have a little bit of a window to what's going on inside your brain. After tinkering with this for a while and mentioned heart rate variability is HRV, was that actually there is an incredibly strong biomarker that correlates with our mental health is not in our brain. It's not between our ears. It's kind of like this conceit that I have as a neuroscientist, which is that everything interesting about the mind would be in the
brain. But gosh, this thing is a beautiful heart. And that signal is what I've been looking on now for almost 10 years.
Tina: So, all right, let's throw the term biofeedback in here. Tell us a little bit about how I have known about biofeedback for a really long time. And I've watched it happen. And I'm just curious how you put that into because people may have heard of that term before, right? How do you put that in perspective with the heart rate variability and the brain activity and the breathing and the meditation? How can you relate all those?
Rohan: Yeah, I think for those of you who don't know, we're listening to what biofeedback is in a short nutshell, you know, is about experiments with biofeedback are around fingertip temperature. And biofeedback is almost like this ability to control parts of your body that you thought
were unconscious. And you do that through technology, which makes those signals kind of like amplified, louder. You can basically hear them, see them, in the case of, you know, leif, which is this product that I work on now, you feel them through vibrations and a haptic,
haptic mode. But the basically biofeedback is this really amazing thing, which is, which is sort of the brain's ability through conscious and unconscious means to hone in on a signal, those first experiments, as I mentioned, were fingertip temperature. And if you have a really accurate digital thermometer, it has to be accurate and it has to mean real time where you're looking at the numbers of, you know, change up and down a little fractions of a degree, right? If you're measuring your finger to temperature, you can actually learn to control your
fingertips temperature consciously with your own well power. Pretty amazing. Then that's biofeedback. You know, applying that to a mental health biomarker, I think was, you know, a really genius, a stroke of genius and that is not due to me or to our team now, at least, it was
invented by a team of scientists, you know, decades ago, some of them are, you know, mentors to us today. And they basically realize that, look, if you provide people feedback on your heart rate and the variation of your heart rate, in real time, you can learn how to self regulate this
physiological response. And for those of us who don't know, I mean, your mind, your emotional state, it's not just within your brain, it's this interaction of your brain and your body, right? Imagine you're in fight or flight, you're anxious, you're feeling sweat bead up on your palms, your heart is racing, your breathing is labored. All of these things are the physiological manifestation of for example, anxiety with any mental health disorder. It seems to be that there's a interplay between the mind and the body, biofeedback is a way to get control of the body.
Tina: So I think biofeedback has its place, right? But I think there's a lot of awareness that needs to go on and what it seems to me that Lief does is take a little bit of that total consciousness out of it, right? And kind of almost, I don't know, it's a vibration, right? So vibrates your body into thinking, your brain into just stopping. Is that, is that fair? Is that a fair characterization?
Rohan: Yeah, so I think basically what it does is, it's really letting you know in real time how your heartrate is changing. And you know, typically when you're relaxed and you're breathing in and out,
your heart rate will actually swing up and down with your breathing when your tense, your high sympathetic, so that doesn't happen easily. So biofeedback for HRV, which again has been done for decades, tons of good research on it for anxiety from mental health broadly. All it really does is give you insight into how your heart's changing so that you can learn how to breathe and change your heart rhythm in real time when you need it, right? It's a skill that you're kind of building.
Serena: So obviously this is audio, but I wonder if you can describe a little bit like what is the device look like? And so people are wearing it, where do they wear it? That kind of thing for our listeners.
Rohan: Yeah, yeah. So we initially started with an Apple Watch trying to build on top of, you know, a wearable that a lot of people had. Unfortunately, it turns out that if you remember in with biofeedback, you need two things. The signal has to be in real time. Your brain
can kind of catch it and learn how to kind of shift it. And it has to be accurate. And if it's not super accurate, you're giving your brain bad information that it never really learns how to control it well. And so that's the idea behind. That's the kind of principle behind why biofeedback tools typically want to be as accurate as possible. And for that reason, we created an ECG patch. So it's a little patch. You slap it on your body. And it's got this haptic interface built into it. So you kind of feel these patterns. And we teach you how to interpret those over eight weeks. And at the end of that, hopefully, and we've shown this in a clinical trial and that's a small clinical trial. But hopefully, at the end of those eight weeks, you're able to not only have a better sense of like, oh gosh, well, I can kind of feel in my body when I'm entering the state of anxiety. But also, you can have that self regulation piece where you're realizing how to breathe in particular ways and really how to change my heart rate, change your heart rate in particular ways in real time to modulate your emotional state. And I think the one thing I could
say that, at least that does better than the other folks is, and this is really my pay point, like why did I even need to build this thing? And myself, all this already. The tool I really wanted was a biofeedback device that would go with me throughout the day when I would need it and be able to turn on in real time in those moments. And that's really hard to do because typically, biofeedback for like, you know, 50 plus years has been either auditory or visual, if you'll sit in a lab and you'll
hear a tone go up and down or you will watch like a ball go up and down the screen or I mean, that's kind of how it's done, right? And what's not convenient about that, I think, for most humans, most human humans is that when you're stressed, you typically can't tell the world like, hey, everybody stop.
Tina: Sorry, I'm laughing, but it's so true.
Rohan: No, and what's funny is that I've been there, I actually tried to do this. And obviously, of course, it doesn't work, right? Of course, it doesn't make sense. And if key insight that I made,
and this is what we built into Leif, you know, you can actually use haptic vibration, this kind of invisible mode of communication to communicate biofeedback to people in real time. So the Lief will turn on when your HRV is well, let's say, you're typically in a higher state of, or at least risk for states of anxiety, depression, et cetera, and when your HRV's
chronically low. And so we'll turn on in those moments and vibrate. And basically, you can kind of like interact with it without needing to let anybody know around you that you're necessarily doing anything. And that's kind of the, yeah, the, the ability to have these micro interventions throughout the day that, that build up and add up and it seems to be helpful for people.
Tina: Yeah, so there is a picture on your website, just if people going back to Serena's question about what it looks like and where people wear it. So there is, and we'll share that in a little bit. I'm curious, because you mentioned this in a previous conversation about it possibly being covered by insurance and how people might get to it. So tell us a little bit more about that.
Rohan: Yeah, I think, you know, he even based on my own experience with mental health, like accessibility was always a challenge. And yeah, so we made, we tried to make his tool, as accessible as possible, it's remote, you could do it mostly on your own, you don't necessarily
need to have a therapist or psychiatrist, you know, in your home town, if that's not something that's, it's possible for you and, you know, unfortunately, 50% of the US counties don't have a, don't have a practice in psychiatrists and huge mental health backlog. We know this from the headlines, but it's, it's an unfortunate situation. And so, so part of what we've tried to do with Lief is make it very accessible by design and also through regulatory mechanisms, like, you know, we have
a version of our product that's an FDA class two device, which means that it can be covered by most insurance companies now. And so, you are Medicaid, if you're on Medicare, most commercial plans now will cover Lief and that can help just bring the cost down for people, you know, where where that might be the difference between taking care and just, you know, trying to carry on.
Serena: Yeah, thank you. So, talk a little bit about who the ideal user of this HRV wearable might be.
Rohan: You know, I, I'm constantly learning through the ideal user because I, I really just built this for myself and, and then I turned out to help other people. So, I think the ideal, the ideal person who might look at HRV biofeedback generally. So, not just, not just our tool, but there is like, there are other tools out there like HeartMath, for example, which has been around for many years and others. And so, I think for someone considering biofeedback, there's an adjunct or as a, as a primary style of mental health intervention, I would say, you know, you might be interested in, in breathing practices and self-regulation practices, maybe you've tried to meditate, maybe you're curious about that. I think another type of person is the biohacker, which was, again, like such a surprise to us, but there's so many people out there that
aren't necessarily feeling not great. They may be feeling just fine, but they want to kind of push themselves from normal to supernormal. And, and so that's a different type of person that might be interested in the biofeedback tool. Somebody who wants to understand how their emotions affect their body and learn how to use their breath really does. You know, I'll help them modulate others when I need to get through the day and a little bit better. Yeah, that's, that's what I know
we've learned so far. I'm sure that we'll keep learning.
Tina: Yeah, those marketing people that are going to keep pushing you. I'm sure of it. I'm sure of it. So, very powerful and I'm curious. So,
we started this episode thinking about that toolbox, right? Like, what tools are in your box? And this could be one of the tools in your box, but aside from this tool for you, what other tools do you personally have in your toolbox to take good care of yourself?
Rohan: Well, you heard my dog.
Tina: One of our favorites, yes.
Rohan: Furry friends, are definitely helpful and we get out and we walk a lot and hike and stuff like that. So, being in nature is another one. I think on, you know, human connection, connecting animals, being in nature, things that allow you to step outside yourself even
for a moment and kind of be and then drop the loops that you might be, you might be at typically with, oh, I got to do this. I got to do that. I've got to do that. I've got better on this.
And why did the first and say that? And there's so many things. And those are all the valid. We have to be humans. We have to live in the world. And that means that, yes, there, there's a lot of details. There's a lot of stuff in them. But anything that can be used to let me drop that for a short period of time, it's, um, I found really helpful.
Serena: That's great. So, tell our audience where they can find you and this device.
Rohan: Yeah. So, you can, you can find the device. You can find a Lief at https://getlief.com/. That's GETLIEF.com. And yeah, please reach out. If anybody has questions, we get back to you as soon as we can. We love talking to folks. Even if, you know, you're not looking to purchase a biofeedback device you may have questions for yourself. We're happy to help them and try to answer them. And we also have a team of amazing train coaches that we work with who can also be very helpful for folks that they need it.
Tina: Right. Rohan, thanks so much for joining us today and sharing about just one more tool we can put in our toolboxes.
Rohan: Thank you.
Serena: So, podcast friends, we are as always grateful for all of you listening and supporting us. You could help us out by visiting Apple Podcasts. Leave us a review while you're there. Subscribe and please share the podcast with others. You'll find more content on our website,
noneedtoexplainpodcast.com. You'll find us on the socials. We would love to hear from you. We have a voicemail number, which you'll find in the notes. You can leave us a message, share a little bit of your story, give us ideas for the podcast or just call to say hi.
Tina: And this is your gentle reminder to take good care of yourself while you are also taking care of your people.
Serena: Thanks for listening.